Texas is again sinking to the bottom of the barrel on a national health care measure.

The state ranks 38th in the nation – down from 29th five years ago – for failing to support emergency patients. That’s according to the latest report card from the Dallas-based American College of Emergency Physicians released Thursday.

Here’s a rundown of how Texas bombed in three of five categories.

* 47th in access to emergency care. The report cited high rates of under-insured folks and low Medicaid fee levels for doctor-office visits as factors. The ACEP urged Texas to boost fees so they are at least “on par” with the national average. It also said it should extend health insurance to more adults and children.

* 42nd in quality care and patient safety. The state’s funding is poor, the report said, for making improvements to ER services.Texas should create statewide standards for “safe and effective” emergency response and care, the group said.

* 49th in public health and injury prevention. The third “F” stems from “extremely high rates of obesity and cyclist and pedestrian fatalities.” The state’s high alcohol-related traffic fatality rate is another driver of the poor score. The ACEP called on Texas to tackle those problems, as well as “racial and ethnic health disparities.”

Since Shelby Regional Medical Center closed in July, Jana Danley and others have petitioned elected officials to help re-establish ER services in the town of Center. The closest hospital is now 21 miles away.

A government shutdown of sorts persists in East Texas.

State and local officials representing Shelby County are still resisting any organized effort to try to remedy the loss of the region’s only emergency room, despite pleas from residents. They also have tried to keep a lid on a public dialogue.

Two months after 18-month-old Edith Gonzalez died needlessly – her parents had nowhere to turn after she choked on a grape – residents of Center continue to petition elected leaders for action. They have collected more than 1,500 signatures asking officials to help reopen Shelby Regional Medical Center or lure a temporary ER facility to town.

The response? Only brief emails or letters have come back from the offices of state Rep. Chris Paddie and Sen. Robert Nichols, noting that they are monitoring the situation. At the local level, city and county officials have avoided calling a town hall meeting to solicit ideas. Nor have they pooled their agencies’ resources to study options.

“How can there be a town hall meeting coming up for a local water tax issue, but not one to address life-saving ER care?’’ said Jana Danley, a former nurse at Shelby Regional Medical Center, which closed in July, leaving the nearest ER facility 21 miles away.

Lt. Gov. David Dewhurst’s office said today that he is likely to order the legislature to investigate the fallout tied to Dr. Tariq Mahmood’s operation of Shelby and his five other rural hospitals. The move would be part of his “interim charges” to lawmakers — a process that helps set the agenda before the next session begins in 2015.

The Texas hospital chain collapsed in recent months amid a government crackdown on substandard care and questionable management practices. Gov. Rick Perry ordered an investigation of his facilities and regulatory failures to rein him in following my investigation of the problems. Mahmood, a Dallas-area businessman, is under federal indictment for billing fraud. He denies wrongdoing. A trial is set for early November.

Sen. Judith Zaffirini, D-Laredo, requested the Dewhurst order for consideration of a “range of policy changes,” including creating a conservatorship program to keep troubled hospitals operating. A Dewhurst spokesman told me “there’s no reason to believe (Zaffirini’s request) wouldn’t be included” among the interim charges.

But Zaffirini said she’s disturbed that Shelby County’s elected officials aren’t pulling together to solve the immediate ER dilemma. She said she hopes those leaders can start working “swiftly and collaboratively.’’

“Leaders who believe that health care is a privilege, not a right, may dismiss this problem as beyond their scope of responsibility,’’ she said. “We who believe that health care is a right respectfully disagree.”

Zaffirini said her “heart goes out to the Gonzalez family.” The toddler’s death “illustrates how access to health care truly can mean the difference between life and death,’’ she said.

Paddie and Nichols have repeatedly declined my requests for interviews.

Shelby County and Center officials have said in recent weeks they are hesitant to get into the hospital business. They say, for example, they are opposed to forming a taxing district to help fund an ER operation, and that residents wouldn’t go for additional taxes.

County Judge Rick Campbell, who previously said he’s reluctant to get county government involved in private health care matters, stressed to me this week that he’s aware of citizens’ worries. He said he had private discussions with various medical professionals and state officials back in August, but no obvious solutions emerged.

He also said he’s trying to plan a meeting in coming days with concerned local doctors to explore the possibility of luring a temporary ER to town.

As for a town hall meeting with the public?

“I just don’t know,” he said, adding he doesn’t think other county officials would go for it.

Feliciano Gonzalez and his wife, Judith Contreras Gonzalez, mourn the loss of their 18-month-old daughter Edith. On Aug. 11, she choked on a grape but when they sought emergency care for her at Shelby Regional Medical Center, it was locked and empty. No ambulances were available in town.

Their options for ER facilities now sit between 21 and 40 miles away, mostly down two-lane highways. And if they need an ambulance, sometimes none is even available if the vehicles already are racing along those routes, as baby Edith’s death showed.

Two other Mahmood hospitals — Cozby-Germany Hospital in Grand Saline and Renaissance Hospital Terrell — have closed. After Cozby’s doors were locked recently, the nearest ER facility became East Texas Medical Center in Quitman, 22 miles away. The next closest: Mother Frances Hospital in Tyler, about 42 miles away.

Terrell folks have fewer miles to drive. Texas Health Presbyterian Hospital in Kaufman sits about 13 miles down the road, and its sister hospital in Rockwall is about 19 miles from Terrell.

To get up to speed on the problems plaguing Dr. Mahmood’s hospitals, the fallout, and the extensive government investigation triggered by our July investigative series, check out this site at DallasNews.com.

The monitors also identified a new type of safety breakdown: Parkland’s police department has been doing a poor job of screening incoming ER patients and visitors for weapons.

There were “a number of events in December and January with potentially dangerous objects not detected,” the monitors wrote. “Checkpoint officers were not consistently adhering to Parkland protocols.”

The officers’ performance improved after retraining, the report says.

An investigation by The News recently identified another problem with the Parkland police force: poor investigation of allegations that caregivers sexually abused patients. No one was arrested in 25 cases the newspaper reviewed, and some people involved in the cases alleged cover-ups. Hospital officials say there has been no effort “to suppress or overlook incidents.”

Since late February, Parkland Memorial Hospital has kept a lid on its do-or-die “corrective action plan.” Even hospital employees, by and large, have not seen it.

Now we’ve finally obtained a copy of the document, in which federally mandated monitors lay out hundreds of patient-safety initiatives that Parkland must complete by next spring to keep its essential Medicare and Medicaid funding. Parkland’s governing board is getting its first report this morning on implementation of the measures.

The Alvarez & Marsal Healthcare Industry Group plan includes no cost estimates, but change clearly will be expensive. The monitors call for major reorganizations, hiring new staff, putting more beds into service and renovating parts of the taxpayer-supported facility — which Parkland plans to vacate when its $1.3 billion new building is complete in 2014.

“In order for this action plan to succeed,” the monitors write, “it must be adopted and embraced not only by Parkland’s Board of Managers and senior leaders, but by every employee and staff member.”

My colleague Miles Moffeit has also obtained an internal Parkland report that says the hospital struggles to detect infection outbreaks. The report describes how a strain of pneumonia spread through the neonatal ICU last year, with two babies dying and nine more made ill.

Alvarez & Marsal said in an early February analysis that despite “multiple campaigns, educational efforts and raised awareness” about hand washing, “lack of compliance with this basic infection prevention technique is prevalent throughout the organization.” The monitors also described patient rooms in which “blood, excrement and trash” hadn’t been cleaned and a pathology lab in which “phone covers had tissue, blood and other substances on them.”

Below are highlights of the monitors’ action plan, with context provided in brackets by The Dallas Morning News.Continue reading →

Med students can’t work as clinicians, says the national accreditation agency whose approval qualifies Parkland for Medicare funding. Clinicians are licensed health-care professionals such as doctors and nurses.

UTSW spokesman Tim Doke said that even though the letter repeatedly calls the med students clinicians and says they do clinical work, they are actually just “administrative assistants.” The professors’ letter never uses that term for the students — who, according to Doke, have no job description.

In Marjorie Stanfield’s column, the parenthetical portion of this sentence jumped out at me: “I had to go through the case manager to arrange a meeting with May’s attending physician (whom we hadn’t met or seen).”